Nonatology:NeonatalRespiratoryDistress第1頁LecturePointsNeonatalpulmonaryfunctionClinicalManifestationThemaincausesMaintypesofthediseaseCasediscussionandpresentationSummaryandconclusion第2頁P(yáng)ulmonaryfunctionofthenewbornsinparticularRelativesmallcapacityofthelungs：limitedreservedvolumepoorcompensation,likelytobedistressedRespiratoryonabdomenanddiaphragmaticmovementDistension:likelytoberespiratorydistressedpulmonarysurfactant(PS)relativeinsmallamountinpretermsandeasilytobedeficiencyDiseasedlungstrendspoorcomplianceandevenARDS第3頁NeonatalRespiratoryDistressGeneralpicturecommonlyoccursduringneonatalperiodcausedbyvariouspathogenesesbreathor、irregular,apneaWithorwithoutretractionatbreathing,suprasternalandintercostalusuallywithcyanosismoreorless第4頁Causationof

neonatalrespiratorydistressUpper

respiratorytract：choana,macrotongue,micrognathiaLarynx/throatandtrachea：inteneratepulmonarydisease：inflammation、abnormalityorhypogenesisothers：congenitalheartdiseasemetabolicproblems,CNScaused第5頁P(yáng)athophysiologyin

neonatalrespiratorydistresshypoxic

and/orhypoventilation

hypoxemia,PCO2

respirationcenterperipheralbiochemicalsensors

breathor、irregular,apnea第6頁

NeonatalRespiratoryDistressHyalineMembraneDisease（HMD、RDS)NeonatalinfectiousPneumoniaMeconiumAspirationSyndrome(MAS)

fordifferentiation第7頁HyalineMembraneDisease（HMD/RDS）Clinicalmanifestationpretermsnormalatbirth,respiratorydistressedinseveralhoursafterbirthprogressivelydevelopinganddeteriorationselfcuredprocessduringthesickness第8頁ClinicalmanifestationAfterbirthcommonlyseen,intrauterineinfectiouspneumoniarelativelylessseenOccurringinneonateswithdifferentGAsandagesGeneralappearanceofinfectionVariousinseverityofrespiratorydistressBlood-gas：PaO2、PaCO2NeonatalinfectiousPneumonia第9頁

MeconiumAspirationSyndrome(MAS)ClinicalmanifestationTermsandpost-termscommonlyseenHistoryofintrauterinedistressamnioticfluid

stainedby

meconiumLowerApgar’sscoreDistressoccurssoonafterbirthTachypneaandwithdrawalatbreathingBlood-gas：PaO2,PaCO2andacidosis第10頁CXR:HMD第11頁CXR:pneumonia第12頁CXR:MAS第13頁CXR:MAS第14頁ClinicalmanagementforneonatalrespiratorydistressMonitoringGeneralappearance：T;response,skincolor,feedingtolerancerespiration（frequency,patternandapnea）Othersystems:HR,liver,abdomenBlood-gas,PaO2、SaO2第15頁ClinicalmanagementforneonatalrespiratorydistressOxygentherapyNasaltubeMaskandtentPressedfacialmaskAttention!fio2O2concentrationROP,CLD/BPD第16頁ClinicalmanagementforneonatalrespiratorydistressMechanicalventilationTarget：earlyinterventionandearlywithdrawIndication：persistentcyanosisunderoxygentherapyRemarkableSaO2PaO2and/orPaCO2

indicatedbyABG

第17頁ClinicalmanagementforneonatalrespiratorydistressMechanicalventilationVentilationmodesandparametersContinuouspositiveairwaypressure(CPAP)：4-8cmH2O;Assistant/control(A/C)：PIP15-25cmH2O；RR25-35；I/E：1：1.5-2.5；PEEP：4-12cmH2OPressuresupportventilation(PSV)：6-10cmH2OHighfrequencyoxillationventilation:HFOV第18頁ClinicalmanagementforneonatalrespiratorydistressMedicationantibioticspenicillin:10-40萬u/kg/dampicillin:50-75mg/kg/dcephalosporin:25-50mg/kg/dPS:80-120mg/kg,1to2dose第19頁ClinicalmanagementforneonatalrespiratorydistressKeepthebabywarmIncubatorRadiatorStableroomtempereture第20頁Clinicalmanagementforneonatalrespirato